Croup disease classification using VGG19 and ResNet50 transfer learning method

Detection of any disease in the early stage can save a life. There are many medical imaging modalities like MRI, FMRI, ultrasound, CT, and X-ray used in the detection of disease. In the last decades, neural network-based methods are effective in detecting and classifying the disease based on abnormalities present in the medical images. Acute laryngotracheobronchitis (croup) is one of the common diseases seen in children among the 0.5-3 years age group which infects the respiratory system that can cause the larynx, trachea, and bronchi. Prior detection can lower the risk of spreading and can be treated accurately by a pediatrician. Commonly this infection can be diagnosed though physical examination. But due to the similarity of Covid-19 symptoms urges the physicians to get accurate detection of this disease using X-ray and CT images of the infant's chest and throat. The proposed work aims to develop a croup diagnose system (CDS) which identify the Croup infection through post anterior (PA) view of pediatric X-ray using deep learning algorithm. We used the well-known transfer learning algorithm VGG19 and ResNet50. Data augmentation being adapted for reducing the overfitting and to improve the quantity of image samples. We show that the proposed transfer learning based CDS method can be used to classify the X-ray images into two classes namely, croup and normal. The experiment results confirm that VGG19 performs better than ResNet50 with promising classification accuracy (90.91%.). The results show that the proposed CDS models can be used for more pediatric medical image classification problem. © 2024 World Scientific Publishing Company.

A Quality Improvement Project Impacts Resident Satisfaction with the Depart Process

Purpose of Study The current depart process resulted in slow work-flow and patient safety and equity concerns. The QI project aimed to improve resident satisfaction with the hospital discharge process. Methods Used The QI project was designed using the Model for Improvement. Starting April 2020, Plan-Do-Study-Act cycles included: hiring clinical team coordinators;creating standard depart instructions for diabetic ketoacidosis, pyelonephritis, seizures, croup and dehydration;uploading instructions to Powerchart;and clinician reminders to use instructions with families. Measures examined monthly, included resident satisfaction and patient readmissions. Summary of Results Resident satisfaction improved from 4.8 (February 2020) to 7.8 (August 2020) for the overall discharge process;from 5.3 to 7.9 for family education on all key points;from 6.0 to 7.7 for smooth transition of care;from 3.0 to 7.4 for no language barriers;and from 3.0 to 6.7 for no unnecessary delays, on a scale of 0/strongly disagree/ terrible to 10/strongly agree/excellent. Readmissions also trended downward. Conclusions During this QI project to address the depart process, resident satisfaction improved and readmissions declined. These results are encouraging, but should be interpreted in the context of decreased patient census due to COVID-19 and non-respiratory season, which may have decreased workload and increased education time and interpreter access. Next steps include PDSAs related to health literacy and Spanish translation.

Respiratory Syncytial Virus, Influenza, and Coronavirus Disease 2019 Hospitalizations in Children in Colorado During the 2021-2022 Respiratory Virus Season.

OBJECTIVE: To compare demographic characteristics, clinical features, and outcomes of children hospitalized with respiratory syncytial virus (RSV), influenza, or severe acute respiratory syndrome coronavirus 2 during their cocirculation 2021-2022 respiratory virus season. METHODS: We conducted a retrospective cohort study using Colorado's hospital respiratory surveillance data comparing coronavirus disease 2019 (COVID-19)-, influenza-, and RSV-hospitalized cases < 18 years of age admitted and undergoing standardized molecular testing between October 1, 2021, and April 30, 2022. Multivariable log-binomial regression modeling evaluated associations between pathogen type and diagnosis, intensive care unit admission, hospital length of stay, and highest level of respiratory support received. RESULTS: Among 847 hospitalized cases, 490 (57.9%) were RSV associated, 306 (36.1%) were COVID-19 associated, and 51 (6%) were influenza associated. Most RSV cases were <4 years of age (92.9%), whereas influenza hospitalizations were observed in older children. RSV cases were more likely to require oxygen support higher than nasal cannula compared with COVID-19 and influenza cases (P < .0001), although COVID-19 cases were more likely to require invasive mechanical ventilation than influenza and RSV cases (P < .0001). Using multivariable log-binomial regression analyses, compared with children with COVID-19, the risk of intensive care unit admission was highest among children with influenza (relative risk, 1.97; 95% CI, 1.22-3.19), whereas the risk of pneumonia, bronchiolitis, longer hospital length of stay, and need for oxygen were more likely among children with RSV. CONCLUSIONS: In a season with respiratory pathogen cocirculation, children were hospitalized most commonly for RSV, were younger, and required higher oxygen support and non-invasive ventilation compared with children with influenza and COVID-19.

COVID-19 is Observed in Older Children During the Omicron Wave in New York City.

BACKGROUND: The Omicron variant of SARS-CoV-2 has a predilection for the upper airways, causing symptoms such as sore throat, hoarse voice, and stridor. OBJECTIVE: We describe a series of children with COVID-19-associated croup in an urban multicenter hospital system. METHODS: We conducted a cross-sectional study of children ≤18 years of age presenting to the emergency department during the COVID-19 pandemic. Data were extracted from an institutional data repository comprised of all patients who were tested for SARS-CoV-2. We included patients with a croup diagnosis by International Classification of Diseases, 10th revision code and a positive SARS-CoV-2 test within 3 days of presentation. We compared demographics, clinical characteristics, and outcomes for patients presenting during a pre-Omicron period (March 1, 2020-December 1, 2021) to the Omicron wave (December 2, 2021-February 15, 2022). RESULTS: We identified 67 children with croup, 10 (15%) pre-Omicron and 57 (85%) during the Omicron wave. The prevalence of croup among SARS-CoV-2-positive children increased by a factor of 5.8 (95% confidence interval 3.0-11.4) during the Omicron wave compared to prior. More patients were ≥6 years of age in the Omicron wave than prior (19% vs. 0%). The majority were not hospitalized (77%). More patients ≥6 years of age received epinephrine therapy for croup during the Omicron wave (73% vs. 35%). Most patients ≥6 years of age had no croup history (64%) and only 45% were vaccinated against SARS-CoV-2. CONCLUSION: Croup was prevalent during the Omicron wave, atypically affecting patients ≥6 years of age. COVID-19-associated croup should be added to the differential diagnosis of children with stridor, regardless of age. © 2022 Elsevier Inc.

Croup associated with COVID-19: A case series.

Background: Croup encounters substantially decreased when the pandemic first began, specifically between March and September 2020, before croup cases dramatically spiked again with the Omicron variant. There is a dearth of information concerning children at risk for severe or refractory COVID-19-associated croup and their outcomes. Objective: The objective of this case series was to describe the clinical characteristics and outcomes of croup associated with the Omicron variant in children, with a focus on cases refractory to treatment. Methods: The case series includes children from birth to 18 years old who presented to a freestanding children's hospital emergency department in the Southeastern United States between December 1, 2021 and January 31, 2022 with a diagnosis of croup and a laboratory-confirmed diagnosis of COVID-19. We used descriptive statistics to summarize patient characteristics and outcomes. Results: Of the total 81 patient encounters, 59 patients (72.8%) were discharged from the ED, with one patient requiring two revisits to the hospital. Nineteen patients (23.5%) were admitted to the hospital, and three of these patients represented to the hospital after discharge from the hospital. Three patients (3.7%) were admitted to the intensive care unit, none of whom represented after discharge. Conclusions: This study reveals a wide age range of presentation as well as a relatively higher rate of admission and fewer coinfections compared to pre-pandemic croup. Reassuringly, the results also show a low postadmission intervention rate as well as a low revisit rate. We discuss four refractory cases to highlight nuances for management and disposition decisions.

Delivery of Epinephrine by Metered-Dose Inhaler for the Treatment of Croup in Children

Study Objective: Croup, also known as laryngotracheobronchitis, is a common pediatric presentation in the emergency department. When children present with moderate or severe croup, epinephrine, either racemic or L-isomer, given by nebulization is considered standard of care. Since the beginning of the SARS-CoV-2 pandemic, many medical institutions have moved away from the delivery of medications by nebulization whenever possible in order to prevent aerosolization of the SARS-CoV-2 virus and infecting others in close proximity. Delivery of respiratory medication by metered-dose inhaler (MDI) was the most commonly adopted method to replace nebulization. Primatene MIST (Armstrong Pharmaceuticals) is an over-the-counter, L-epinephrine MDI. In February 2021, the Pediatric Service Line Pharmacy and Therapeutics Committee of the Northwell Health system approved the use of Primatene MIST in children >= 1 years old presenting to the emergency department with croup as an alternative to nebulized epinephrine. We aim to demonstrate that L-epinephrine administered by MDI is safe and effective in children presenting with moderate croup. Study Design/Methods: We conducted a single-center retrospective chart review study of children 1 to 17 years of age who presented to the emergency department at Cohen Children's Medical Center and were evaluated for suspected croup from March 2021 until May 2022. As part of a surveillance and later reapproval process by the Pediatric Service Line Pharmacy and Therapeutics Committee of the Northwell Health system for Primatene MIST, data was prospectively collected and entered into a REDCap database. This included Westley Croup Score, requirement of additional doses of epinephrine, adverse events, disposition, and return within 48 hours. During the initial rollout, eligible patients were administered 4 puffs through an attached spacer. Following safety review, dosing was increased to 6 puffs. Result(s): A total of 24 pediatric patients with croup received Primatene MIST. The mean age was 3.3 years (SD:2.3 years) and 75% were male. Of the 16 patients who had respiratory viral testing, 19% tested positive for SARS-CoV-2 virus. The median Westley Croup Scores at presentation was 3 (IQR:2,3;Range:2-5), 0 (IQR:0,1;Range:0-4) at 30 minutes and 0 (IQR:0,1;Range:0-3) at 120 minutes following Primatene MIST administration. A second dose of epinephrine (nebulized or MDI) was administered to 7 patients (29.2%;CI:14.9%-49.2%). Only 1 patient (4.2%) was admitted and 1 (4.2%) returned within 48 hours. There were no reported adverse events. Conclusion(s): Epinephrine administered by MDI is a safe and effective treatment for moderate croup. It should be considered as an alternative to nebulized epinephrine when there are concerns for infectious aerosolization. No, authors do not have interests to disclose Copyright © 2022

Etiology and Epidemiology of Croup before and throughout the COVID-19 Pandemic, 2018-2022, South Korea.

Omicron, a recent variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently globally dominating. We reviewed the etiology and epidemiology of croup over an approximately 5-year period, with an emphasis on the recent dominance of the Omicron variant. Children less than 5 years of age seen in the emergency department with diagnosis of croup from two large national tertiary hospitals were collected for the period from January 2018 through March 2022. Viral etiologies of the patients were compared with national surveillance data upon circulating respiratory viruses in the community. A total number of 879 croup cases were recognized during the study period. The most common pathogen was SARS-CoV-2 (26.9%), followed by HRV (23.8%), PIV1 (14.6%), PIV3 (13.1%), and CoV NL63 (13.1%), among seventeen respiratory viral pathogens tested by polymerase chain reaction. The viral identification rate was significantly higher in the Omicron period, with most of the pathogens identified as SARS-CoV-2. In the Omicron period, with the exponential increase in the number of COVID-19 cases in the community, croup associated with SARS-CoV-2 significantly increased, with a high detection rate of 97.2% (35 of 36) among croup cases with pathogen identified. The etiologic and epidemiologic data before and throughout the COVID-19 pandemic indicate that the association between croup and infection with the SARS-CoV-2 Omicron variant is highly plausible.

EARLY DESCRIPTIVE STUDY OF PEDIATRIC ED VISITS FOR COVID-19 DURING THE OMICRON WAVE IN QUEENS, NY

SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Two years into the COVID-19 pandemic, knowledge about how infection affects children is still lacking. Unlike adults, prior to the recent surge widespread symptomatic childhood illness has not been seen, likely due to school shutdowns, strict social distancing, and less severe illness course. During the omicron surge in NYC, an increase in pediatric cases was noted likely due to reinstatement of in-person learning and relaxing of social distancing. Though vaccines were available, only 9% of children aged 5-11 years and 35% of adolescents aged 12-17 years were vaccinated. During omicron surge, a large proportion of adult patients positive for COVID-19 were asymptomatic. We aimed to explore incidence of ED visits, hospital admissions, vaccine status and presenting complaints in pediatric population who tested positive for COVID-19 during the omicron surge in NYC. METHODS: A retrospective chart review was conducted of patients <18 years who tested positive for COVID-19 at two multiethnic community hospitals during the Omicron wave (Nov 1, 2021-Feb 28, 2022). Demographics, vaccine status, reason for visit, diagnosis and disposition were extracted from EHR. Data were analyzed according to age group: 0 to <5 years (G1), 5 to <12 years (G2) and 12 to <18 years (G3). RESULTS: During this time, close to 2800 patients tested positive for COVID-19 at presentation to the ED or during hospitalization. Of these, 343 were <18 years of age (~10%). Overall, 53% of these pediatric patients were male. Ethnic make-up mirrored that of our community (approx. 60% Hispanic, 20% Asian, 10% Black). Admission status included 27 (7.8%) admitted to our hospitals, 18 (5.2%) transferred to other hospitals from our ED, and 298 (87%) treated and released from the ED. By age group, 183 (59%) were in G1, 76 (24%) in G2 and 51 (17%) in G3. Patients in G1 were <5 years and therefore ineligible for vaccine. Only 5% of G2 and 33% of G3 were fully vaccinated. In all groups, majority of patients presented for symptoms of viral infection (G1>80%, G2>90%, G3>90%). Symptoms of upper respiratory infection were most frequent in all groups (>80%). Convulsions (4.3%, 1.3%), croup (8.2%, 2.6%) and otitis media (3.3%, 1.3%) were noted in G1 and G2, respectively. In G3, acute appendicitis, diabetic ketoacidosis, and otitis media were present on admission in 2% each. Majority of patients requiring admission were from G1 (74%). CONCLUSIONS: Though adults during the recent surge often presented with asymptomatic COVID-19, pediatric patients in our sample typically presented for viral illness. It is difficult to interpret vaccine data except to say that there was a small group of pediatric patients who were symptomatic despite vaccination. CLINICAL IMPLICATIONS: We present early descriptive data from the Omicron surge in NYC in a pediatric sample. DISCLOSURES: No relevant relationships by Won Baik-Han No relevant relationships by Tamana Bismillah No relevant relationships by Kelly Cervellione no disclosure on file for Gagan Gulati;No relevant relationships by LOCHANA KC No relevant relationships by Lily Lew

CLINICAL IMPACT OF COMMUNITY ACQUIRED RESPIRATORY VIRUSES IN PATIENTS WITH SOLID ORGAN TRANSPLANTS

SESSION TITLE: Not the Normal Host: Infections Still Matter SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Community Acquired Respiratory Viruses (CARVs) are associated with poor outcome in Solid Organ Transplant (SOT) recipients. We reviewed some of these outcomes such as respiratory support, length of stay (LOS), ICU admission, steroid use & 30-day all-cause mortality. METHODS: Multihospital, single center, retrospective review of electronic health records from 01/01/2014-12/31/2019. RESULTS: 23 SOT recipients (M=20, F=3) who tested positive for CARVs were identified. SOT distribution was heart=2, kidney=4, liver=3, lung=11, heart-lung=1, lung-kidney=1 & heart-kidney=1. Mean age at admission was 60 years, average LOS was 8 days with 2 pts needing >2 weeks. 6 pts required intensive care unit;8 pts required supplemental oxygen support. 16 pts had infiltrates on chest imaging. 15 pts had a 90-day readmission with respiratory complaints. 8 pts had bronchoscopy & 20 had positive nasal swab. 3 pts had a negative nasal swab but positive Bronchoalveolar lavage (BAL) for CARV while 2 pts had negative BAL but positive nasal swab. CARV distribution was Rhinovirus 48%, Parainfluenza 29%, Metapneumovirus 12%, Respiratory syncytial virus 0.03%, Adenovirus 0.03% & Non-novel Coronavirus 0.06%. 5 pts had bacterial coinfection (Pseudomonas aeruginosa, Corynebacterium striatum & Stenotrophomonas maltophilia). All pts were immunosuppressed, intravenous immunoglobulins (IVIG) were used in 3 pts, antivirals in 7 pts (ribavirin in 6 & oseltamivir in 1) & steroids in 10 pts. 12 pts had transplant organ biopsy with 5 showing acute cellular rejection. 11 pts had underlying Coronary artery disease and 17 pts had hematologic disorders (Post-transplant lymphoproliferative disorder, leukemia, Myelodysplastic syndrome, & multiple myeloma). 35% pts died within 1 year (2 during same admit). Cause of death was refractory septic shock (1), respiratory failure (3), cardiac arrest (3) & chronic lung allograft dysfunction (CLAD) (1). CONCLUSIONS: In this cohort, we assessed the SOT recipients positive for CARVs who required admission & evaluated the impact on their clinical course. This analysis noted a significant rate of acute & chronic rejections, bronchiolitis obliterans and CLAD in these patients. Newer tests like multiplex NAT & (semi) quantitative NAT (QNAT) can diagnose CARVs in addition to Human Influenza Virus. Patients can present with wheezing, croup, bronchiolitis, pneumonitis & pneumonia. Impact of CARVs seems to vary by the type of organ transplant, level of neutropenia/lymphopenia, upper versus lower respiratory infection and intrinsic pathogenicity of virus. Various preventive & therapeutic measures were employed in an attempt to improve outcomes in these patients. CLINICAL IMPLICATIONS: Transplant receipients are at a high risk of infections especially CARVs which may increase morbidity and mortality. This analysis emphasizes the value of timely diagnosis and treatment in this specific patient population who are immunocompromised. DISCLOSURES: No relevant relationships by Supriya Singh

Mild-to-Moderate Croup Presentations in Patients With COVID-19 Infection.

This case series will describe two pediatric patients, aged nine months and two years, who presented to the emergency department with symptoms of croup. However, they were later found to have coronavirus disease 2019 (COVID-19). The two patients had no pre-existing medical conditions, and they were treated with steroids and nebulized epinephrine as required. They were discharged home with instructions to follow up with their primary care provider and to follow isolation guidelines. This report will illustrate how upper respiratory symptoms, including those consistent with croup, can be associated with or caused by an existing COVID-19 infection. More research is needed to determine if this association can lead to more long-term complications of COVID-19. Additionally, testing for COVID-19 should be incorporated into the assessment and management of this presentation. By recognizing this, clinicians can identify the cause of the illness sooner and initiate targeted treatment more effectively.

The presentations and management of acute Covid-19 infection in secondary care in South East Scotland

AimsTo review the presentations and management of children and young people presenting with acute Covid-19 requiring hospital admission in South East Scotland.MethodsRetrospective identification of children testing positive for Covid-19 infection at time of admission to the Royal Hospital for Children and Young People (RHCYP) in Edinburgh over a 10 month period from March 2021 to January 2022 inclusive, with review of their presentations and management. Patients who presented with PIMS-TS were excluded.Results109 children who were admitted to RHCYP over a 10 month period, tested positive for Covid-19 infection on day of admission, age range of 2 days to 16 years old. The mean age at presentation was 4 years and 1 month of age, with 39% of children (43) under 6 months of age, 28% (31) between 6 months and 5 years of age, 16% aged 5 to 12 years of age (17) and 17% aged over 12 years (18). Children with symptomatic Covid-19 infection had a wide array of presentations, including viral induced wheeze, bronchiolitis, croup and superimposed pneumonia, with the most commonly utilised treatments being oxygen, steroids and nebulisers. However, in those under 6 months of age, only 23% required any treatment for Covid-19 infection, whilst 58% of those aged 6 months to 5 years required treatment for symptomatic Covid-19 infection. Only 37% (40) of children presenting with Covid-19 infection required treatment for respiratory tract infection. In those children requiring treatment for symptomatic respiratory tract infection, the most commonly utilised treatments in the ward setting were oxygen (24, 60%), steroids (20, 50%) and nebulisers or inhaled bronchodilators (12, 30%);only one child required treatment with remdesivir (0.9%). Patients presenting under 3 months of age with pyrexia and Covid-19 positive frequently received IV antibiotics to cover pyrexia of unknown origin until microbiology was returned, with no other specific treatment required (13, 12%).ConclusionOf the 109 patients admitted with or because of Covid-19, the majority were under 6 months of age, whilst children aged 6 months to 5 years more commonly required specific treatment for Covid-19 infection. Many of these 109 children with Covid-19 infection did not require any treatment (45, 40%), or were treated for other illnesses with Covid-19 felt to be incidental (9, 8.3%). Many (25, 23%) children tested positive for multiple viruses including Covid-19, making the particular burden of Covid-19 infection unclear.

Simulation beyond sim centers -virtual simulation experience using virtual resuscitation room (VRR)for paediatric emergency medicine learners during the covid -19 pandemic at the paediatric emergency department of the hospital for sick children in Toronto

AimsTo implement virtual simulation for the PEM training utilizing the Virtual resuscitation room (VRR) during COVID in the paediatric emergency department at The Hospital for Sick ChildrenMethodsAfter need assessment the gaps in the simulation based education for the learners in the paediatric ED were identified. The VRR was identifies as a fit to overcome the barriers. The VRR is a free low cost, interactive, collaborative approach to online simulation based education, adopted from the community ED team. It is a simple platform created using Zoom and google slide interface. The VRR had already been utilized for Medical students and adult EM training with high face validity. Therefore, it was adopted it for PEM. As per the learners needs 12 PEM cases were transformed to the VRR platform including, septic shock, croup, asthma, status epilepticus and DKA. Orientation and training session for using the VRR was organized for simulation fellows, PEM fellows and educators in the department separately. The training sessions were conducted for the Residents, Fellows and EM trainees and Community EM physicians. Debriefing was conducted utilizing the plus delta methodology with a standardized checklist provided to Facilitators. Feedback from both facilitators and learners were taken after each session regarding its Usability and feasibility.ResultsTotal 10 sessions with 120 learners had been provided simulation based Education using the VRR. Total 12 common Paediatric PEM cases were developed to entail the need of the learners. There were 30% junior learners and 70% senior learners. Facilitators described it easy to use tool (83%) and feasibility in developing new cases (77%). They were able to modify or increase complexity as per the level of learners(80%) and interactive (86%). The facilitators felt that it was not useful in teaching resuscitation procedural skills (87%). The Learners feedback was taken on the Likert scale of 1-5 where 1 was least likely and 5 was most likely. Ninety seven percent of learner rated 4.4 out of 5 when said that they learnt something that is applicable to their clinical practise, 82% rated 4.3 out of 5 about the fact that the physiological clues, props, technology, and environment facilitated learning on VRR. The Debriefing was rated as 4.8/5 by 92% of the learners using the virtual platform. 97% of the learners were felt engaged in the virtual simulation and 94% felt that clinical clues provided like respiratory distress, capillary refill time, seizures were felt real. Most of the learners (87%) said that that difficult to learn procedural task.ConclusionVRR was found to be a feasible and useful platform to deliver simulation based education for PEM learners.

Clinical characteristics of pediatric patients with COVID-19 between Omicron era vs. pre-Omicron era.

INTRODUCTION: Detailed data on clinical characteristics in children with the omicron strain of SARS-COV-2 are limited. METHODS: We conducted a retrospective observational study of children with COVID-19 at the National Center for Child Health and Development to evaluate the clinical manifestations during and before the emergence of the omicron variant. Only symptomatic patients without underlying diseases were included. Participants were divided into two temporal groups: the "omicron era" (1/2022-2/2022) and the "pre-omicron era," where the delta variant predominated (7/2021-11/2021). The patients were subclassified into an older vaccine-eligible group (aged 12-17 years), a younger vaccine-eligible group (aged 5-11 years), and a vaccine-ineligible group (aged 0-4 years). RESULTS: We compared 113 patients in the omicron era with 106 in the pre-omicron era. Most patients in both eras had non-severe disease, and no patients required mechanical ventilation or died. Among patients aged 0-4 years, sore throat and hoarseness were more common during the omicron era than the pre-omicron era (11.1% vs. 0.0% and 11.1% vs. 1.5%, respectively). Croup syndrome was diagnosed in all patients with hoarseness. Among patients aged 5-11 years, vomiting was more frequent during the omicron era (47.2%) than during the pre-omicron era (21.7%). Cough and rhinorrhea were less common during the omicron era in patients aged 0-4 and 5-11 years, respectively, than during the pre-omicron era. CONCLUSIONS: In children with COVID-19, clinical manifestations differed between the omicron and pre-omicron eras. In the Omicron era, croup syndrome was more frequent in vaccine-ineligible children.

Croup during the Coronavirus Disease 2019 Omicron Variant Surge.

We conducted a retrospective review of medical records of patients with croup seen during the coronavirus disease 2019 pandemic. Approximately 50% underwent testing for severe acute respiratory syndrome coronavirus 2. During the Delta wave, 2.8% of those tested were positive for severe acute respiratory syndrome coronavirus 2; this increased to 48.2% during the Omicron wave, demonstrating a strong correlation between the Omicron variant and croup.

Two Case Reports of Life-Threatening Croup Caused by the SARS-CoV-2 Omicron BA.2 Variant in Pediatric Patients.

Croup is a common upper airway infection characterized by a barking cough, stridor, and hoarseness. It is usually caused by viral infection. A small number of croup caused by coronavirus disease 2019 (COVID-19) has been reported in children before the omicron variant surge. Previously reported cases indicated that croup caused by COVID-19 can be treated in the same manner as those with other viral causes. We describe two cases (9-month-old girl and 11-month-old boy) of previously healthy infants who presented with a barking cough and chest retraction and required endotracheal intubation and cardiopulmonary resuscitation. Despite receiving dexamethasone and nebulized racemic epinephrine (NRE) treatment for croup in the emergency department, these patients still developed acute respiratory failure. Reverse transcription polymerase chain reaction (RT-PCR) of nasopharyngeal samples revealed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron BA.2 variant (Stealth omicron) and no other common respiratory viral pathogens. Both patients were treated with mechanical ventilation, dexamethasone, and NRE in the pediatric intensive care unit. The duration of intubation was 112 hours and 80 hours, respectively. Both patients were discharged without complications. To the best of our knowledge, this is the first report of life-threatening croup produced by the omicron BA.2 variant and confirmed by RT-PCR. We suggest that this SARS-CoV-2 variant may cause severe croup that may not improve with conventional treatment, even in children without underlying diseases.

Croup as a Manifestation of SARS-CoV-2 Omicron Variant Infection in Young Children.

Croup is an acute upper respiratory disease primarily caused by the parainfluenza virus. Owing to inflammation and edema of the upper airways, children present with barky cough and stridor, and some may experience respiratory distress. We investigated children aged < 5 years with coronavirus disease 2019 (COVID-19) admitted to two hospitals in Seoul, South Korea, and observed a spike in croup cases during the omicron surge. Among the 569 children admitted from March 1, 2021 to February 25, 2022, 21 children (3.7%) had croup, and the proportion of croup cases was significantly higher during the omicron wave than that during the delta wave (12.4% vs. 1.2%, P < 0.001). With the immediate administration of corticosteroids and epinephrine via nebulizer, the symptoms improved rapidly. During the current omicron surge, careful monitoring of the symptoms of croup in young children is needed for the diagnosis of COVID-19 and its timely management.

Croup Associated With SARS-CoV-2: Pediatric Laryngotracheitis During the Omicron Surge.

In this retrospective analysis, we describe weekly croup and corresponding viral prevalence patterns in a pediatric quaternary care system in metropolitan Atlanta. We characterize a series of 24 patients with croup associated with SARS-CoV-2 infection and show that this clinical presentation increased substantially in frequency during the period of high Omicron vs Delta transmission.

Emergency Department Visits for Pediatric Infectious Conditions Decrease After COVID-19

Study Objective: Following the arrival of COVID-19 in the New York metropolitan area in March 2020, pediatric ED visits markedly decreased. Possible reasons for this include parental reluctance to bring their children to the ED due to fear of exposure and mandates to socially isolate (which may have also decreased infectious disease transmission) and increasing use of telemedicine. Our goal was to determine whether ED visits for some common pediatric infectious conditions changed following the arrival of COVID-19 in our area. Methods: Design: Retrospective cohort. Setting: EDs of 28 hospitals within 150 miles of New York City. Of these, 5 hospitals had dedicated pediatric EDs. Hospitals were teaching or non-teaching and rural, suburban or urban. Annual ED volumes were from 12,000 to 122,000. Population: consecutive ED patients ≤ 18 years old between March 1 and November 30 in 2019 and 2020. Data analysis: We arbitrarily chose to examine the following conditions: otitis media, bronchiolitis, streptococcal pharyngitis, croup and diarrhea, identified by the International Classification of Diseases codes, version 10. We tallied total visits and visits for each of these diagnoses in 2019 and 2020 time periods. We report the percentage changes in visits from 2019 to 2020 along with their 95% confidence intervals (CIs). Results: The database contained 300,627 visits in 2019 and 2020. From 2019 to 2020, total visits decreased by 58%, from 211,018 in 2019 to 89,609 in 2020. Visits in 2019 and 2020 respectively, were: otitis media (7080, 1775);bronchiolitis (2041, 267);streptococcal pharyngitis (2813, 863);croup (2547, 389) and diarrhea (3533, 900). This represents the following decreases from 2019 to 2020: otitis media 75% (95% CI 73-76%), bronchiolitis 87% (95% CI 85-88%), streptococcal pharyngitis 69% (95% CI 67-71%), croup 85% (95% CI 83-86%) and diarrhea 74% (95% CI 73-76%). Conclusion: Total pediatric ED visits and visits for specific infectious conditions markedly decreased following the arrival of COVID-19 in our area. Further studies are needed to investigate the impact that the reduction in ED visits had on patient clinical outcomes.

Epidemiological and clinical characteristics of infections with seasonal human coronavirus and respiratory syncytial virus in hospitalized children immediately before the coronavirus disease 2019 pandemic.

INTRODUCTION: Seasonal human coronavirus (HCoV)-229E, -NL63, -OC43, and -HKU1 are seasonal coronaviruses that cause colds in humans. However, the clinical characteristics of pediatric inpatients infected with HCoVs are unclear. This study aimed to compare and clarify the epidemiological and clinical features of HCoVs and respiratory syncytial virus (RSV), which commonly causes severe respiratory infections in children. METHODS: Nasopharyngeal swabs were collected from all pediatric inpatients with respiratory symptoms at two secondary medical institutions in Fukushima, Japan. Eighteen respiratory viruses, including RSV and four HCoVs, were detected via reverse transcription-polymerase chain reaction. RESULTS: Of the 1757 specimens tested, viruses were detected in 1272 specimens (72.4%), with 789 single (44.9%) and 483 multiple virus detections (27.5%). RSV was detected in 639 patients (36.4%) with no difference in clinical characteristics between RSV-A and RSV-B. HCoV was detected in 84 patients (4.7%): OC43, NL63, HKU1, and 229E in 25 (1.4%), 26 (1.5%), 23 (1.3%), and 16 patients (0.9%), respectively. Patients with HCoV monoinfection (n = 35) had a significantly shorter period from onset to hospitalization (median [interquartile range] days, 2 [1-4.5] vs. 4 [2-5]), significantly shorter hospitalization stays (4 [3-5] vs. 5 [4-6]), and more cases of upper respiratory infections (37.1% vs. 3.9%) and croup (17.1% vs. 0.3%) but less cases of lower respiratory infection (54.3% vs. 94.8%) than patients with RSV monoinfection (n = 362). CONCLUSION: Seasonal HCoV-infected patients account for approximately 5% of children hospitalized for respiratory tract infections and have fewer lower respiratory infections and shorter hospital stays than RSV-infected patients.